Citation Nr: 0100508
Decision Date: 01/09/01 Archive Date: 01/17/01
DOCKET NO. 99-20 992 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Buffalo,
New York
THE ISSUE
The propriety of the initial rating of 50 percent for post
traumatic stress disorder (PTSD).
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
M. Ferrandino, Associate Counsel
INTRODUCTION
The veteran had verified active service from July 1963 to
October 1967. It is further indicated on his DD Form 214
that he had one month and five days of additional service.
In February 1997, the veteran filed a claim for service
connection for PTSD. This appeal arises from the July 1999
rating decision from the Buffalo, New York Regional Office
(RO) that granted service connection for PTSD and assigned an
evaluation of 10 percent, effective February 28, 1997. A
Notice of Disagreement was filed in August 1999 and a
Statement of the Case was issued in September 1999. A
substantive appeal was filed in September 1999 with no
hearing requested.
By a rating decision in November 1999, the RO increased the
evaluation for the veteran's service-connected PTSD from 10
percent to 50 percent, effective February 28, 1997, and
granted a temporary total rating based on hospitalization for
treatment of PTSD from August 16, 1999, through September 30,
1999. The 50 percent rating was reinstated effective October
1, 1999. The veteran has continued his appeal of what is in
effect the initial 50 percent rating assigned with the grant
of service connection for PTSD.
REMAND
The latest VA examination regarding PTSD was in September
1997. At that time, the veteran's global assessment of
functioning (GAF) was considered to be 51-60. The veteran
was thereafter hospitalized at a VA medical center from
August 16, 1999 to September 10, 1999 for treatment of PTSD.
His PTSD was considered severely disabling and the veteran's
GAF was 38. There has been no further VA psychiatric
examination of the veteran since discharge from VA
hospitalization. Therefore, another examination should be
ordered to determine the current status of the veteran's
PTSD.
The criteria as contained in 38 C.F.R. Part 4, Diagnostic
Code 9411 (as in effect from November 7, 1996) are as
follows:
A 10 percent evaluation is assignable for
PTSD in the presence of occupational and
social impairment due to mild or
transient symptoms which decrease work
efficiency and ability to perform
occupational tasks only during periods of
significant stress, or; symptoms
controlled by continuous medication.
A 30 percent evaluation is provided in
the presence of occupational and social
impairment with occasional decrease in
work efficiency and intermittent periods
of inability to perform occupational
tasks (although generally functioning
satisfactorily, with routine behavior,
self-care, and conversation normal), due
to such symptoms as: depressed mood,
anxiety, suspiciousness, panic attacks,
(weekly or less often), chronic sleep
impairment, mild memory loss (such as
forgetting names, directions, recent
events).
A 50 percent evaluation is to be assigned
for occupational and social impairment
with reduced reliability and productivity
due to such symptoms as: flattened
affect; circumstantial, circumlocutory,
or stereotyped speech; panic attacks more
than once a week; difficulty in
understanding complex commands;
impairment of short- and long-term memory
(e.g., retention of only highly learned
material, forgetting to complete tasks);
impaired judgment; impaired abstract
thinking; disturbances of motivation and
mood; difficulty in establishing and
maintaining effective work and social
relationships.
A 70 percent evaluation is assigned for
occupational and social impairment, with
deficiencies in most areas, such as work,
school, family relations, judgment,
thinking, or mood, due to such symptoms
as: suicidal ideation; obsessional
rituals which interfere with routine
activities; speech intermittently
illogical, obscure, or irrelevant; near-
continuous panic or depression affecting
the ability to function independently,
appropriately and effectively; impaired
impulse control (such as unprovoked
irritability with periods of violence);
spatial disorientation; neglect of
personal appearance and hygiene;
difficulty in adapting to stressful
circumstances (including work or a
worklike setting); inability to establish
and maintain effective relationships).
A 100 percent evaluation is provided for
total occupational and social impairment,
due to such symptoms as: gross impairment
in thought processes or communication;
persistent delusions or hallucinations;
grossly inappropriate behavior;
persistent danger of hurting self or
others; intermittent inability to perform
activities of daily living (including
maintenance of minimal personal hygiene);
disorientation to time or place; memory
loss for names of close relatives, own
occupation, or own name.
Accordingly, this matter is Remanded for the following
action:
1. The RO should obtain and associate
with the claims file copies of all VA
treatment records and private medical
records, reflecting treatment for PTSD
since the veteran was discharged from VA
hospitalization in September 1999.
Inquiry should be made of the veteran as
to the dates and places of any such
psychiatric treatment.
2. Thereafter, the veteran should be
afforded a VA psychiatric examination in
order to determine the current severity
of his service connected PTSD. The
claims file must be made available to the
examiner prior to the examination. The
RO should provide to the examiner a copy
of this Remand which contains the rating
criteria pertaining to the veteran's
PTSD. The examiner should state in his
report that the claims folder has been
fully reviewed in connection with the
examination. All clinical findings
should be reported in detail. The
examiner should comment as to the
presence or absence of every symptom and
finding required for ratings from 10
percent to 100 percent, and, where
present, the frequency and severity
thereof.
3. The RO should readjudicate the
veteran's claim for an increased initial
rating for PTSD. Consideration should be
given to the recent case of Fenderson v.
West, 12 Vet. App. 119 (1999). Therein,
the Court held that, with regard to
initial ratings following the grant of
service connection, separate ratings can
be assigned for separate periods of time
based on the facts found-a practice
known as "staged" ratings. If any
decision remains adverse to the veteran,
he and his representative should be
afforded a supplemental statement of the
case and afforded the appropriate
opportunity to respond.
Thereafter, the case should be returned to the Board, if in
order. The appellant has the right to submit additional
evidence and argument on the matter or matters the Board has
remanded to the regional office. Kutscherousky v. West, 12
Vet. App. 369 (1999).
This claim must be afforded expeditious treatment by the RO.
The law requires that all claims that are remanded by the
Board of Veterans' Appeals or by the United States Court of
Appeals for Veterans Claims for additional development or
other appropriate action must be handled in an expeditious
manner. See The Veterans' Benefits Improvements Act of 1994,
Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994),
38 U.S.C.A. § 5101 (West Supp. 2000) (Historical and
Statutory Notes). In addition, VBA's Adjudication Procedure
Manual, M21-1, Part IV, directs the ROs to provide
expeditious handling of all cases that have been remanded by
the Board and the Court. See M21-1, Part IV, paras. 8.44-
8.45 and 38.02-38.03.
BRUCE E. HYMAN
Veterans Law Judge
Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 2000), only a
decision of the Board of Veterans' Appeals is appealable to
the United States Court of Appeals for Veterans Claims. This
remand is in the nature of a preliminary order and does not
constitute a decision of the Board on the merits of your
appeal. 38 C.F.R. § 20.1100(b) (2000).